1. Virtual Environments for
Games Based Reflective Learning
focused on health applications
Lucia Pannese
26 February 2013

2. Serious Games Market Growth
“The serious games industry as a whole
was worth some $1.2 billion in 2010, and
is estimated to grow to $10 billion by
2015.”
Jurriaan Van Rijswijk, chairman of
the Games for Health conference
(Nov 2012)

3. Established Factors for Serious Games Success
• Proof that serious games are effective,
especially for education and health
• Higher levels of development productivity
and speed to implement
• Engagement, immersion and realism

4. The Cost of Healthcare
“by 2050 the cost of direct health care
in just the U.S. for Alzheimer's is going
to be $1 trillion. Caring for sufferers of
the disease is already a $200 billion
market in the U.S.”
Dr. John Harrison, a psychologist
at Imperial College, London

5. Fields of application of Serious Games &
simulations in Healthcare
 Supporting therapy, rehabilitation after severe illness
 Self‐management of illness /chronic conditions (e.g. diabetes)
 “Exergames“ ‐ motivating and supporting physical activity and
healthy lifestyle
 Anonymous group therapy
 Preventive medicine
 Behavioural change
 Healthy Nutrition
 Train healthcare professionals (medical procedures, methods for
diagnosis, patient monitoring …..)
 Doctor‐patient communication

6. The MIRROR Project
Reflective Learning at Work
encourage human resources to reflect on previous experiences at the
workplace and learn from them. The project's focus is the creation of a set
of applications that enable employees to learn lessons from their own
experiences (as well as from the experiences of others) and thereby
improve their future performance
@MirrorIP www.mirror-project.eu
LinkedIn: MIRROR – reflective learning at work

7. SCENARIO
Nurses and Carers have to cope with a high level of stress in their
working shifts.
They are trained on the medical side and in procedures, but some
support to deal with “challenging behaviour” is needed.

8. OBJECTIVE
Creating a game that…
▪ Reduces tutorial effort
▪ Enhances learners capability to self-regulate learning
▪ Connects the virtual and the real experience
▪ Makes learners / players reflect on experience
▪ Connects previous and future experience (backwards and forward
reflection)
▪ Motivates learners and engages them

9. CHARACTERISTICS
This game should…
▪ Display a 3D graphics
▪ Be immersive
▪ Be simple to play
▪ Vary the form of the interactivity
▪ Show a high level of fidelity in the look and feel
▪ Incorporate a virtual tutor
▪ Allow to revise the learning experience and reflect on it

10. THEORETICAL FRAMEWORK
▪ The Virtual Tutor is based on Vygotsky’s social learning theory
that emphasizes the essential nature of social dimensions to
learning.
▪ The importance of peer learning was stressed in the development
of the Zone of Proximal Development (ZDP) defined as ‘the
distance between the actual development level as determined by
independent problem solving and the level of potential
development as determined through problem solving under adult
guidance or in collaboration with more capable peers’
▪ The Zone is not some clear-cut space that exists independently of
the process of joint activity itself but it is created in the course of
collaboration.
(Vygotsky, 1978)

11. THE VIRTUAL TUTOR
▪ acts as co-learner able to support learners’ knowledge construction;
▪ provides a cognitive model of competent performance;
▪ has no position of authority with respect to the learner, because this
create a trusting relationship that might facilitate self-disclosure of
ignorance and misconception;
▪ monitors learner performance;
▪ diagnoses, corrects and manages misconceptions and errors;
▪ adds to and extends learners’ current capabilities;
▪ modifies learners’ current capabilities;
▪ rebuilds new understanding when learners have a misconception.

12. Link with a Reflection Model
clarify the connection between the reflection model and games in
order to improve the MIRROR conceptualization of serious games as
tools for reflection
“Do work” step in the 3D game

13. The Learning Diary
Conduct reflection
session in the 3D
game (post game)

14. THE VIRTUAL HOSPITAL

15. DIALOGUES

16. THE iPAD

17. MINI-GAMES

18. VIRTUAL TUTOR: PUSH and PULL
Push: learners can ask for the help of Pull: in some precise situation Maria
Maria whenever they feel it is relevant. appears inside the game through a
pop-up window to help users deal with
difficult situations

19. FORMATIVE EVALUATION
‘This would have been ‘The Virtual Tutor is a ‘Mini games are really
really helpful when we good support inside fun and teach me
first started’. the game’. something that seems
to be really important’.
‘It’s really helpful’. ‘I was really immersed ‘Tutor really helps me
inside the game’. during the game’.
‘Mrs Violet looks exactly ‘The game is really ‘The tutor’s feedback, the
like Mrs XX and she says innovative, I like the scores and the learning
exactly those sorts of way patients are diary help me to reflect
things!’. distributed inside the about my game
environment, the experience’.
challenges I have to
address and the mini
games’.

20. video

21. Insights and Lessons Learned
Normally a coach/facilitator supports the transfer exercise between
virtual and real experiences:
▪ We have shown that part of this support can be transferred into a
game, adding it as a narrative element, without breaking the plot
and the engagement. Users find it useful and like it.
▪ The virtual tutor supports self-regulated learning.
▪ The logics and mechanics of this virtual tutorial support is
transferrable to other domains.

22. Next Steps….
New Scenarios:
• Emergency training in a hospital after an earthquake
• Flexible working styles in a modern company
• Soft skills training

23. Next Steps….
New Features:
▪ User generated content through NPCs (authoring tool)
▪ Dynamic scenes (repeatability)

24. THE MIRROR PROJECT
@MirrorIP
www.mirror-project.eu
LinkedIn: MIRROR – reflective learning at work

25. A serious game to introduce autistic people into a job
www.ispectrum.eu
@iSpectrumEU

26. • 3 workplace scenarios:
• Office
• Small supermarket
• Commercial garden centre
• 6 phases each:
• Avatar selection
• Short interview at a work placement office
• Short interview with the new employer
• First day at work
• About a month into work
• About 3 months into work

28. Each scenario contains a range of situations relating to both the work being
undertaken and the social situations that may be encountered in the workplace
with raising difficulty; e.g:
• When to shake the Boss’s hand
• Identification of facial emotions exhibited by colleagues.

29. Buddy:
Peer-to-peer learning:
The buddy appears in each of the work scenarios. His job is to guide the
player through the early stages of the game. He does this through
instructions, and by giving feedback to the player’s choices.
In a real world scenario new employees can hopefully have
more experienced and empathic employee as a buddy.

31. Project Objective
Extensive investigation of the issues related to long-term
physical/cognitive rehabilitation processes and the identification of
suitable technical solutions to efficiently support them
Develop an efficient, effective and engaging virtual rehabilitation
environment for home-based rehabilitation to enable elderly people
to enjoy high quality rehabilitation for a much longer period than the
Health System can currently afford.
Standard hardware components and devices, suitable medical data
processing algorithms, personalized and serious-games based
rehabilitation pathways, Web2.0 social and communication tools

32. Games Based Rehabilitation
• provide exercises and training - based on serious-games -
within a personalized, user friendly and engaging rehabilitation
program
• offer a cost effective infrastructure with integrated sensors
• collect relevant physical and medical parameters for patients’
status inspection and prevention
• support off-line/on-line management and monitoring of the
rehabilitation protocol
• promote patient’s social participation and community building
Patient’s home: place where physical and cognitive rehabilitation
process can be performed in an intensive and engaging though
controlled way, while promoting social inclusion and quality of life.

33. Thank you for
your attention!
Lucia Pannese
CEO, imaginary srl Mob. +39 338 8785839
Innovation Network Politecnico di lucia.pannese@i-maginary.it
Milano Skype: lueolli
@lpannese
Via Mauro Macchi, 50 - 20124 Milan
Phone +39 02 89458.576 www.i-maginary.it